HB2423 102ND GENERAL ASSEMBLY

LRB102 15042 SPS 20397 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2423

Introduced 2/17/2021, by Rep. Robert Rita

SYNOPSIS AS INTRODUCED:

210 ILCS 45/3-202.05
210 ILCS 45/3-206a new

Amends the Nursing Home Care Act. Provides that the Department of Public Health shall certify the Temporary Nursing Assistant Training Program that it implemented by emergency rule. Provides that the Department shall deem an individual who has completed a training program and competency assessment under the Temporary Nursing Assistant Training Program as satisfying the requirement of completing a nurse aide training and competency evaluation program approved by the State under specified eligibility provisions. Provides that a person shall be deemed to have completed the eligibility provisions if they have completed all nursing assistant training and competency evaluation program requirements and shall be placed on the State nurse aide registry as "active". Provides that temporary nursing assistants must enroll in an approved certified nursing assistant training program no later than 2 years after completion of the Temporary Nursing Assistant Training Program. Provides that, once enrolled in the certified nursing assistant training program, the individual may work as a nursing assistant in training and continue to practice the same skills he or she did as a temporary nursing assistant and new competencies he or she has learned in his or her certified nursing assistant training. Makes conforming changes.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

WHEREAS, During the COVID-19 pandemic, federal and State regulatory and statutory provisions have been waived to assist in the hiring of temporary nurse assistants; and

WHEREAS, Individuals have served admirably and compassionately in this capacity and have demonstrated through accelerated training and experience competency to transition to fully registered status as a nurse aide; and

WHEREAS, This program created 1,700 jobs in communities where people found themselves out of work due to closures and gave them a pathway to excel in the healthcare career ladder; and

WHEREAS, Upon the cessation of the program on January 18th, 2021, many nursing homes have continued to receive applications from a number of unemployed individuals wanting to join the Temporary Nursing Assistant Training Program; and

WHEREAS, While nursing homes are experiencing shortages in staff, State certification of the Program will provide additional help to care for loved ones, create jobs, and expand the need of increased workforce in the nursing home sector as they transition into a certified nurse assistant certification; and

WHEREAS, Temporary nurse assistants are required to successfully complete a State-approved training and evaluation in order to be employed as a nurse aide in a skilled nursing facility; and

WHEREAS, The purpose of this training is to ensure that nurse aides have the education, practical knowledge, and skills needed to care for residents of facilities participating in the Medicare and Medicaid programs; and

WHEREAS, As a matter of public policy, the Temporary Nursing Assistant Program should take into account training and experience acquired during the COVID-19 pandemic to transition these individuals to placement on the State's nurse aide registry; therefore

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Nursing Home Care Act is amended by changing Section 3-202.05 and by adding Section 3-206a as follows:

(210 ILCS 45/3-202.05)

Sec. 3-202.05. Staffing ratios effective July 1, 2010 and thereafter.

(a) For the purpose of computing staff to resident ratios, direct care staff shall include:

(1) registered nurses;

(2) licensed practical nurses;

(3) certified nurse assistants;

(4) psychiatric services rehabilitation aides;

(5) rehabilitation and therapy aides;

(6) psychiatric services rehabilitation coordinators;

(7) assistant directors of nursing;

(8) 50% of the Director of Nurses' time; and

(9) 30% of the Social Services Directors' time; and .

(10) temporary nursing assistants in the Temporary Nursing Assistants Training Program under Section 3-206a.

The Department shall, by rule, allow certain facilities subject to 77 Ill. Admin. Code 300.4000 and following (Subpart S) to utilize specialized clinical staff, as defined in rules, to count towards the staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities federally defined as Institutions for Mental Disease. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

Within 120 days of the effective date of this amendatory Act of the 97th General Assembly, the Department shall promulgate rules specific to the staffing requirements for facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013. These rules shall recognize the unique nature of individuals with chronic mental health conditions, shall include minimum requirements for specialized clinical staff, including clinical social workers, psychiatrists, psychologists, and direct care staff set forth in paragraphs (4) through (6) and any other specialized staff which may be utilized and deemed necessary to count toward staffing ratios.

(b) (Blank).

(b-5) For purposes of the minimum staffing ratios in this Section, all residents shall be classified as requiring either skilled care or intermediate care.

As used in this subsection:

"Intermediate care" means basic nursing care and other restorative services under periodic medical direction.

"Skilled care" means skilled nursing care, continuous skilled nursing observations, restorative nursing, and other services under professional direction with frequent medical supervision.

(c) Facilities shall notify the Department within 60 days after the effective date of this amendatory Act of the 96th General Assembly, in a form and manner prescribed by the Department, of the staffing ratios in effect on the effective date of this amendatory Act of the 96th General Assembly for both intermediate and skilled care and the number of residents receiving each level of care.

(d)(1) (Blank).

(2) (Blank).

(3) (Blank).

(4) (Blank).

(5) Effective January 1, 2014, the minimum staffing ratios shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care.

(e) Ninety days after the effective date of this amendatory Act of the 97th General Assembly, a minimum of 25% of nursing and personal care time shall be provided by licensed nurses, with at least 10% of nursing and personal care time provided by registered nurses. These minimum requirements shall remain in effect until an acuity based registered nurse requirement is promulgated by rule concurrent with the adoption of the Resource Utilization Group classification-based payment methodology, as provided in Section 5-5.2 of the Illinois Public Aid Code. Registered nurses and licensed practical nurses employed by a facility in excess of these requirements may be used to satisfy the remaining 75% of the nursing and personal care time requirements. Notwithstanding this subsection, no staffing requirement in statute in effect on the effective date of this amendatory Act of the 97th General Assembly shall be reduced on account of this subsection.

(f) The Department shall submit proposed rules for adoption by January 1, 2020 establishing a system for determining compliance with minimum staffing set forth in this Section and the requirements of 77 Ill. Adm. Code 300.1230 adjusted for any waivers granted under Section 3-303.1. Compliance shall be determined quarterly by comparing the number of hours provided per resident per day using the Centers for Medicare and Medicaid Services' payroll-based journal and the facility's daily census, broken down by intermediate and skilled care as self-reported by the facility to the Department on a quarterly basis. The Department shall use the quarterly payroll-based journal and the self-reported census to calculate the number of hours provided per resident per day and compare this ratio to the minimum staffing standards required under this Section, as impacted by any waivers granted under Section 3-303.1. Discrepancies between job titles contained in this Section and the payroll-based journal shall be addressed by rule.

(g) The Department shall submit proposed rules for adoption by January 1, 2020 establishing monetary penalties for facilities not in compliance with minimum staffing standards under this Section. No monetary penalty may be issued for noncompliance during the implementation period, which shall be July 1, 2020 through September 30, 2020. If a facility is found to be noncompliant during the implementation period, the Department shall provide a written notice identifying the staffing deficiencies and require the facility to provide a sufficiently detailed correction plan to meet the statutory minimum staffing levels. Monetary penalties shall be imposed beginning no later than January 1, 2021 and quarterly thereafter and shall be based on the latest quarter for which the Department has data. Monetary penalties shall be established based on a formula that calculates on a daily basis the cost of wages and benefits for the missing staffing hours. All notices of noncompliance shall include the computations used to determine noncompliance and establishing the variance between minimum staffing ratios and the Department's computations. The penalty for the first offense shall be 125% of the cost of wages and benefits for the missing staffing hours. The penalty shall increase to 150% of the cost of wages and benefits for the missing staffing hours for the second offense and 200% the cost of wages and benefits for the missing staffing hours for the third and all subsequent offenses. The penalty shall be imposed regardless of whether the facility has committed other violations of this Act during the same period that the staffing offense occurred. The penalty may not be waived, but the Department shall have the discretion to determine the gravity of the violation in situations where there is no more than a 10% deviation from the staffing requirements and make appropriate adjustments to the penalty. The Department is granted discretion to waive the penalty when unforeseen circumstances have occurred that resulted in call-offs of scheduled staff. This provision shall be applied no more than 6 times per quarter. Nothing in this Section diminishes a facility's right to appeal.

(Source: P.A. 101-10, eff. 6-5-19.)

(210 ILCS 45/3-206a new)

Sec. 3-206a. Certification of temporary nursing assistants.

(a) The Department shall certify the Temporary Nursing Assistant Training Program that it implemented by emergency rule under 77 Ill. Adm. Code 395.2.

(b) Notwithstanding the State-approved nurse aide training programs, the Department shall deem an individual as satisfying the requirement of completing a nurse aide training and competency evaluation program approved by the State if:

(1) the individual successfully completed a training program and competency assessment under the Temporary Nursing Assistant Training Program, including online training and an online examination;

(2) the individual completed a minimum of 80 hours of temporary nursing assistant or supervised practical nurse aide training, on-the-job training apprenticeship, or regular in-services nurse aide education during the declared COVID-19 emergency under the supervision of a licensed or registered nurse; or

(3) the individual's competency has been established by one of the following:

(A) successful completion of the State temporary nursing assistant examination;

(B) certification by a site administrator responsible for assessing the individual's competency skills as part of an approved apprenticeship program; or

(C) through an assessment in all areas of required nurse aide training as provided for in 42 CFR 483.152(b) by the hiring entity.

(c) Individuals who meet the eligibility provisions in subsection (b) shall be deemed to have completed all nursing assistant training and competency evaluation program requirements and shall be placed on the State nurse aide registry as "active".

(d) Temporary nursing assistants must enroll in an approved certified nursing assistant training program within 2 years of completion of the Temporary Nursing Assistant Training Program.

The individual shall receive one hour of credit for every hour employed as a temporary nursing assistant, up to 40 hours.

Once enrolled in the certified nursing assistant training program, the individual may work as a nursing assistant in training and continue to practice the same skills he or she did as a temporary nursing assistant and new competencies he or she has learned in his or her certified nursing assistant training.

(e) The Department shall incorporate this Section as part of the State-approved nurse aide training programs.